Healthcare Provider Details

I. General information

NPI: 1144654658
Provider Name (Legal Business Name): GREATER BOSTON ADULT DAY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 -10 LIVINGSTONE ST.
DORCHESTER MA
02124
US

IV. Provider business mailing address

6 -10 LIVINGSTONE ST.
DORCHESTER MA
02124
US

V. Phone/Fax

Practice location:
  • Phone: 508-294-8756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IGOR SHREYER
Title or Position: OWNER
Credential:
Phone: 508-294-8756